Rheumatic fever
Posted by dkwinter

     Untreated steptococcal pharyngitis
     Developing nations due to lack of access to antibiotics
     New murmur
     Cardiac failure
          Migratory in nature and usually affects lower extremity joints first
     Skin lesions known as Erythema Marginatum
     Subcutaneous nodules

     ASO titer provides evidence of recent streptococcal infection and is positive in patients with acute rheumatic fever
     Jones criteria is used for diagnosis
          Evidence of a Group A Strep infection along with
               2 major criteria OR
               1 major criterion plus 2 minor criteria
          Major criteria
               Carditis (e.g. pericarditis, CHF, or new heart murmur--mitral stenosis is the most common valvular complication of rheumatic fever)
                    -migratory in nature and usually affects the lower extremity joints first
               Rash (erythema marginatum)
               Subcutaneous nodules
          Minor criteria
               Elevated acute phase reactants
               Prolonged PR interval
     Repeated episodes of rheumatic fever can worsen valvular function. Therefore it is recommended that patients with a prior episode of rheumatic fever be given antibiotic prophylaxis with penicillin to prevent a recurrence. The duration of treatment is not firmly established, but most physicians will treat until the patient reaches the age of 18.
     Patients who have had an episode of rheumatic fever should receive antibiotic prophylaxis with penicillin to prevent further attacks
     Pulmonary congestion
               Exertional dyspnea
               Nocturnal cough
     Mitral stenosis, leading to
          Left atrial dilation and subsequently atrial fibrillation